5.  The applicant was born in 1954 and lives in Ohrid.
6.  The applicant is suffering from multiple sclerosis.
7.  On 1 April 1994 the Ministry of Health (“the Ministry”) issued a certificate allowing a bank, in which the applicant’s father had a foreign currency savings account, to transfer 20,000 United States dollars into the account of a hospital in the United States, in order to cover medical expenses related to treatment which the applicant was expected to undergo. It was given on the basis of a medical report (конзилијарно мислење) issued by the Skopje Neurology Clinic which stated, inter alia:
“... [the applicant] is suffering from multiple sclerosis, which requires further medical examination and treatment in a medical institution abroad, given the fact that all possibilities for her treatment in the State are exhausted ...”
8.  Between 17 May and 28 June 1994 the applicant underwent medical treatment in the hospital H.H.I. in the United States.
9.  On 12 July 1994 the Skopje Neurology Clinic issued another medical report (конзилијарно мислење, “the report of 12 July 1994”), the relevant part of which reads as follows:
“It is impossible to treat the disease in the State due to the critical state of [the applicant’s] health and the Clinic’s calendar of events. [The applicant] should leave immediately or by the middle of the month at the latest ...”
10.  The report was signed by three doctors, who confirmed that it was impossible to treat the disease in the respondent State. As stated in the report, it was expected that the treatment abroad would prevent the progressive deterioration of the applicant’s health.
11.  On 29 November 1994 the applicant requested that the Health Insurance Fund (“the Fund”) issue ex post facto a decision referring her to be treated in hospital H.H.I. (решение за упатување на лекување во странство). This request did not contain a claim for reimbursement of the expenses for the treatment that she had undergone.
12.  On 8 December 1994 the Fund dismissed the applicant’s request after an expert commission set up within the Fund (“the Fund’s commission”) had provided an opinion that the applicant could have been treated in the respondent State.
13.  On 21 March 1995 the applicant appealed against the Fund’s decision to the Ministry, arguing that the Fund’s expert commission had not taken into account the report of 12 July 1994 (see paragraph 9 above). She also requested that the Ministry approve further check-ups and treatment in hospital H.H.I.
14.  On 30 November 1995 the Ministry, as the second-instance administrative body, dismissed the applicant’s appeal after obtaining an opinion from the Second-Instance Medical Commission for Treatment Abroad (“the Second-Instance Commission”). The Ministry found that the possibilities for treatment in the State had not been exhausted.
15.  The applicant initiated administrative-dispute proceedings before the Supreme Court. On 14 January 1998 the Supreme Court quashed the Ministry’s decision. It found that it had not been clear whether the applicant was supposed to undergo a medical check-up or prolonged treatment abroad and that there was a contradiction in the medical reports as to whether the possibilities to treat the applicant’s condition domestically had been exhausted.
16.  On 9 July 1999 the Ministry again dismissed the appeal by the applicant against the Fund’s decision of 8 December 1994.
17.  In so far as can be established from the available material, on 7 July 1995 the applicant lodged a separate request with the Fund for reimbursement of the expenses for the treatment that she had undergone in hospital H.H.I.
18.  On 21 September 1995 the Fund ordered a partial reimbursement of the medical expenses in the amount of 278,311 Macedonian denars (MKD), or 20% of the expenses actually incurred. On 12 November 1995 the decision was adjusted to 10%. It appears that on 13 November 1995 the awarded amount was increased to MKD 313,100.
19.  On 11 November 1996 the Ministry examined the applicant’s appeal and increased the award by an additional MKD 50,215.
20.  The applicant challenged the latter decision with an administrative-dispute claim before the Supreme Court.
21.  On 25 March 1998 the Supreme Court quashed the decision of 11 November 1996. It found that the Fund and the Ministry had failed to assess whether the applicant could have been treated in the State, in accordance with the Rules on the Conditions and Manner of Referral of Insured Persons for Treatment Abroad (see paragraphs 38-41 below). It further found that these bodies interpreted section 15 of the Rules to signify that a person was not entitled to reimbursement of expenses if he/she had not obtained a prior decision referring him/her for treatment abroad (решение за упатување на лекување во странство). In the court’s view, such an interpretation would be contrary to the Health Protection Act.
22.  On 6 January 1999 the Ministry reached an identical decision to that of 11 November 1996.
23.  The applicant initiated administrative-dispute proceedings against the Ministry’s decision.
24.  On 22 November 2000 the Supreme Court quashed both the decision of 6 January 1999 (see paragraph 22 above) and the decision of 9 July 1999 (see paragraph 16 above). It found that the Ministry should have joined the proceedings for reimbursement of the medical expenses incurred in hospital H.H.I. with the proceedings for referral for treatment abroad. It should have decided in the first place the request for referral to treatment abroad, the outcome of which was decisive for the applicant’s claim for reimbursement of the medical expenses. It again instructed the Ministry to assess whether the applicant could have been treated in the State.
25.  On 23 February 2001 the Ministry quashed the decision of 21 September 1995 (see paragraph 18 above) and decided that the applicant’s treatment abroad could not be recognised as treatment abroad based on a decision of the Fund. Nevertheless, the applicant was to be reimbursed the expenses for treatment abroad not based on such a decision, in the amount of MKD 378,741. The Ministry came to its conclusion on the basis of an opinion of a medical commission of 14 December 2000 which found that the applicant could be treated in the respondent State.
26.  The applicant again challenged the Ministry’s decision before the Supreme Court.
27.  On 13 November 2003 the Supreme Court quashed the decision, finding that the administrative bodies had not established whether at the time of the treatment the possibilities for treatment in the respondent State had been exhausted.
28.  On 5 November 2004 the Ministry again dismissed the appeal against the decision of 21 September 1995, this time based on a conclusion of the Second-Instance Commission of 3 November 2004 that the applicant could have been treated in the respondent State in 1994.
29.  On 14 December 2006 the Supreme Court again quashed the decision of the Ministry. The court found that there had been conflicting medical evidence as to whether the applicant could have been treated in the respondent State at the relevant time. It further requested that the doctors who had drawn up the report of 12 July 1994 give evidence as to whether the possibilities for treatment of the specific condition in the State in 1994 had been exhausted.
30.  After having consulted the doctors, on 8 October 2007, the Ministry again dismissed the applicant’s appeal against the decision of 21 September 1995. The relevant part of the decision reads as follows:
“The Minister of Health ... on the basis of all the documents in the file established that the [applicant’s] treatment in the [H.H.I. hospital] cannot be considered as treatment abroad based on a decision of the [Fund] in accordance with sections 7, 9 and 10 of the Rules for Referral for Treatment Abroad (Official Gazette nos. 3/92, 11/92, 32/92 and 48/92) and in accordance with sections 5, 7 and 8 of the subsequently adopted Rules on the Manner of Using Health Services Abroad (Official Gazette no. 111/2000) because under the provisions of both sets of Rules the medical opinion of the respective clinic is merely a proposal for referral for treatment abroad of an insured person, and the assessment and the opinion on the need for treatment abroad is provided by the [Fund’s commission], which assesses whether the possibilities for treatment in the State are exhausted and whether there are possibilities for successful treatment abroad, in which State and in which foreign medical facility.
The insured person obtains the right to treatment abroad only by a decision of the [Fund] on the basis of a finding of the [Fund’s commission]. It is a fact that the [applicant] went for treatment abroad without [having obtained] a decision of the [Fund] on her own assessment, given that at that moment there was not even a medical report [by the clinic] which is only a proposal of the clinic for referral to treatment abroad.
In the entire proceedings the first- and second-instance bodies acted in accordance with the provisions of the Rules for [Referral to Treatment Abroad] and, in line with section 15 of the Rules, they decided to reimburse expenses as if the treatment had been performed in the [respondent] State, for the reason that the [applicant] had not obtained a right to be treated abroad because the competent commission had found that that condition had been treatable in the State ...
... That the Supreme Court in its last judgment requests that the members who provided the medical report of 1994 [give evidence] ... is irrelevant, given that the medical report is an initiative – a proposal for initiating certain proceedings – but [it does] not [confer] a right to be treated abroad.
If, in the court’s view, the medical report was decisive in the present case, a question arises as to what the competence of the [Fund’s commission] is and why there are provisions in the Rules ... and prescribed proceedings for obtaining the right to treatment abroad.
Having in mind the fact that the [Fund’s commission] for referral for treatment abroad, in the present case, had on multiple occasions found that the possibilities for treatment in the existing health institutions at the Skopje Clinic had not been exhausted ... the case is considered under section 15 [of the Rules of 1992], that is section 20 [of the Rules of 2000] ... , and it was decided that expenses for the treatment be reimbursed to the [applicant] in line with the price list for health services in the [respondent State].”
31.  The applicant challenged the Ministry’s decision seeking under the Administrative Disputes Act (see “Relevant domestic law” below) that the Supreme Court hold an oral hearing in order to take evidence from the doctors who had drawn up the 1994 report, the Chairman of the Ministry’s Second-Instance Commission and Dr R.L., the doctor who had treated her. She referred to the certificate of 1 April 1994 (see paragraph 7 above) and the medical report that it had been based on. She argued that, in view of her condition at that juncture and the short period of available time, she had not lodged a request to the Fund before leaving as she had considered that she could have done it after her return to the State. She further argued that the Ministry had failed to decide her claim for referral for treatment abroad and had only decided the claim for reimbursement of expenses.
32.  On 22 January 2009 the Administrative Court, which had meanwhile become competent to decide administrative disputes, held a private session and finally dismissed the applicant’s appeal. It did not in its decision address the applicant’s request for an oral hearing.
33.  The court referred to section 10 § 1 (14) and section 30 of the 2000 Health Insurance Act, as well as sections 20 of the Rules on the Manner of Using Health Services Abroad (see paragraphs 37, 41 and 42 below). It ruled that the administrative bodies had correctly applied the applicable law in awarding the applicant partial compensation for the medical expenses for her treatment in hospital H.H.I. in 1994. The relevant parts of the judgment stated as follows:
“... In the present case, [the applicant] went for treatment abroad without [having obtained] a decision of [the Fund], on her own assessment, and without a medical report, which she obtained after she had returned from the U.S.A. from the Skopje Neurology Clinic on 12 July 1994, contrary to section 30 of the 2000 Health Insurance Act.
The court considers that the [administrative] bodies in the proceedings correctly established that the [applicant’s] treatment in the [H.H.I.] hospital in the U.S.A. cannot be considered as treatment abroad based on a decision of [the Fund] in accordance with sections 7, 9 and 10 of the Rules for referral for treatment abroad (Official Gazette nos. 3/92, 11/92, 32/92 and 48/92) and in accordance with sections 5, 7 and 8 of the Rules on the Manner of Using Health Services Abroad (Official Gazette no. 111/2000), because under the provisions of the two [sets of] Rules the medical report of the relevant clinic is only a proposal for referral for treatment abroad of an insured person, and the assessment and the opinion on the need for treatment abroad is provided by the [Fund’s commission], which assesses whether the possibilities for treatment in the State are exhausted and whether there are possibilities for successful treatment of the condition abroad and in which country or in which foreign medical institution.
In deciding, the court assessed [the applicant’s] arguments that in [the respondent State] there had been no possibility of a successful continuation of her treatment and that there had been a need to continue the treatment abroad, but found them groundless since, according to the expert opinion of the Neurology Clinic, all cases of multiple sclerosis have always been treated in the State wherein the therapeutic procedures for these diseases are in accordance with international medical standards. Hence, the court considers that the [administrative] bodies acted in accordance with the Supreme Court’s instructions and removed the breaches in the proceedings in terms of clarification of the contradictions which had existed before, deciding to award expenses as if the treatment had been conducted in the State, under the terms of section 15 of the Rules for Referral to Treatment Abroad, given that [the applicant] had not obtained the right to be treated abroad because the competent [Fund’s commission] had provided its opinion that the condition had been treatable in the State.”
34.  This judgment was served on the applicant on 6 March 2009.